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PubMed1995

[The effect of long-term monotherapy with preparations from the 4 basic groups of antihypertensive agents on the quality of life in patients with mild and moderate arterial hypertension. The Multicenter Captopril and the Quality of Life Study. The working group of the Multicenter Captopril and the Quality of Life Study].

A multicenter, controlled, open, randomized trial of antihypertensive and life quality (LQ) effects of monotherapy with captopril vs propranolol, hydrochlorothiazide and nifedipine included 345 males aged 35-60 years with mild and moderate hypertension. The results of 8-month treatment provided the conclusions: the drugs were much alike by antihypertensive efficacy, LQ parameters proved more beneficial in the group on captopril than those on nifedipine and propranolol, hydrochlorothiazide failed to improve life quality, captopril is an effective and safe antihypertensive drug superior to the drugs of 3 other antihypertensive drug groups by positively affecting LQ.

Adult↗
PubMed1999

Sensitivity to change of generic quality of life instruments in patients with rheumatoid arthritis: preliminary findings in the generic health OMERACT study. OMERACT/ILAR Task Force on Generic Quality of Life. Life Outcome Measures in Rheumatology. International League of Associations for Rheumatology.

This is the initial report of the generic health OMERACT study concerned with the sensitivity to change of generic quality of life (QOL) measures. Our objective was to determine which QOL instrument is best able to show a statistically significant improvement in patients with rheumatoid arthritis (RA) demonstrating relevant improvement in a core set of disease activity and disease-specific disability measures. A multicenter controlled trial of a single group with repeated measurements at 0 (baseline), 3, and 6 months was conducted. All participating centers recruited 10 patients with RA who were about to start methotrexate therapy for the first time because of active disease. Assessments included disease activity measures, disease-specific disability measures, and generic QOL measures. To date, 40 patients have been recruited from 4 centers for the study. After 6 months of treatment many of the generic QOL measures showed a 20% improvement from baseline and medium standardized response means around 0.5. In particular, the Nottingham Health Profile (NHP) and the Rheumatoid Arthritis Quality of Life (RAQOL) measures had the largest percentage improvement (22 and 29%, respectively) and standardized response means (both with 0.54). Early results on the sensitivity of generic health QOL measures are promising, in particular for the NHP and RAQOL measures.

Antirheumatic Agents↗
PubMed1999

Humanistic qualities in end-of-life care: lessons from the diving bell and the butterfly: a memoir of life in death-required reading in an end-of-life care curriculum for internal medicine residents.

OBJECTIVE: Reading a literary account of a terminal illness to develop humanistic qualities and attitudes for effective end-of-life care. METHOD: The Diving Bell and the Butterfly: A Memoir of Life in Death by Jean-Dominique Bauby is an autobiographical account of Mr. Bauby's experiences in the locked-in state after he suffered a brain stem stroke at age 43. Each resident was given a copy of this paperback to read over 4 weeks. Interns (PGY-1) were on a 4-week oncology ward rotation, and all junior and senior residents (PGY-2 and PGY-3) were on elective rotations during this period. Residents were instructed to mark their favorite passages of the book, to be prepared to read aloud such passages in small-group sessions, and to explain why they chose the specific passage. Attendance was mandatory, and residents were asked to complete a questionnaire at the end of the small-group discussion. RESULTS: Eighteen PGY-ls and 30 PGY-2/3s completed the curriculum. Seventeen of 18 PGY-ls read the entire book, and all 30 PGY-2/3s read the book from cover to cover. Only 3 of 18 PGY-1 residents felt that the task of reading this book interfered with their work. More than 90% of the residents felt that reading the book clearly improved their attitudes toward the care of the terminally ill patient. Lessons learned from the book included all the humanistic qualities important in caring for the terminally ill and severely disabled. CONCLUSION: Well-chosen narratives of literature can be a powerful tool to learn attitudes and humanistic qualities in the care of the terminally ill.

Journal Article↗
PubMed2002

Quality of life after ileal pouch-anal anastomosis: an evaluation of diet and other factors using the Cleveland Global Quality of Life instrument.

PURPOSE: Although functional results after ileal pouch-anal anastomosis are excellent, imperfections of function do occur. In this setting, quality-of-life assessment is an invaluable tool in determining overall therapeutic efficacy. We evaluated the impact of dietary restrictions, preoperative diagnosis (ulcerative colitis vs. familial adenomatous polyposis), and pregnancy (after pouch insertion) on quality of life. METHODS: After ethical approval, 64 patients were reviewed (mean age, 31 (range, 15-54) years). Long-term quality of life in patients after ileal pouch-anal anastomosis was assessed using the Cleveland Global Quality of Life instrument or Fazio score. The Cleveland Global Quality of Life score is a novel quality-of-life instrument specifically designed for patients with ileal pouches. Stool frequency and continence were recorded to establish the functional status of this group. RESULTS: Sixty-one patients (95.3 percent) complained of some form of dietary restriction and adopted a fixed dietary regimen. All such patients felt that a breach of this regimen would impinge significantly on their quality of life. Late eating and alcohol were associated with diarrhea, whereas smoking was not. Constipation was infrequently reported. The mean Cleveland Global Quality of Life score of patients with ulcerative colitis (0.81 +/- 0.13) was greater than that of patients with ulcerative colitis and a background of pouchitis (0.78 +/- 0.16; P = 0.042). Whereas postoperative stool frequency in patients with familial adenomatous polyposis was always higher than the preoperative level (4 vs. 2 movements per day; P = 0.04), the Cleveland Global Quality of Life score of this group was lower than that of ulcerative colitis patients (0.77 vs. 0.81; P = 0.047). The Cleveland Global Quality of Life score of females who had had pregnancies after pouch formation was 0.70, significantly lower (P = 0.039) than that of ulcerative colitis patients, although pouch function was similar to the general group (7 vs. 6 daily bowel movements with full continence in all parous patients). CONCLUSIONS: Most patients suffered dietary restrictions, forcing them to adopt a fixed dietary regimen. Breach of this regimen would impact on their quality of life. Hence composition of diet and timing of intake are important determinants of quality of life after ileal pouch formation. Patients with familial adenomatous polyposis and those with a history of pouchitis had poorer Cleveland Global Quality of Life scores than ulcerative colitis patients without a background of pouchitis. This indicates that they also had poorer quality of life. Parous patients had the lowest Cleveland Global Quality of Life scores, indicating the poorest quality of life. These differences did not correlate with poorer pouch function, highlighting the influence of non-pouch-related factors in quality of life after ileal pouch formation.

Adenomatous Polyposis Coli↗
PubMed2003

Quality of life theory I. The IQOL theory: an integrative theory of the global quality of life concept.

Quality of life (QOL) means a good life and we believe that a good life is the same as living a life with a high quality. This paper presents the theoretical and philosophical framework of the Danish Quality of Life Survey, and of the SEQOL, QOL5, and QOL1 questionnaires. The notion of a good life can be observed from subjective to the objective, where this spectrum incorporates a number of existing quality of life theories. We call this spectrum the integrative quality-of-life (IQOL) theory and discuss the following aspects in this paper: well being, satisfaction with life, happiness, meaning in life, the biological information system ("balance"), realizing life potential, fulfillment of needs, and objective factors. The philosophy of life outlined in this paper tries to measure the global quality of life with questions derived from the integrative theory of the quality of life. The IQOL theory is an overall theory or meta-theory encompassing eight more factual theories in a subjective-existential-objective spectrum. Other philosophies of life can stress other aspects of life, but by this notion of introducing such an existential depth into the health and social sciences, we believe to have taken a necessary step towards a new humility and respect for the richness and complexity of life.

Humans↗
PubMed1996

The Life Attitudes Schedule Short Form: an abbreviated measure of life-enhancing and life-threatening behaviors in adolescents.

An abbreviated version of the Life Attitudes Schedule (LAS) was developed, consisting of 24 items, each representing one cell of the original LAS theoretical matrix (4 content categories x 2 behavior types x 2 valence). Items were retained on the basis of high correlations with LAS total score and low correlations with gender. Psychometric properties of the LAS Short Form were robust and the Short Form total score correlated .93 with the original LAS total score. As with the original LAS, boys reported more injury-related behaviors than girls. Future research and clinical directions are suggested.

Adolescent↗
PubMed2003

The relations between social support, life stress, and quality of life following spinal decompression surgery.

STUDY DESIGN: Assessed social support, life stress, and quality of life among degenerative spine disease patients. OBJECTIVE: To examine how social support and life stress relate to quality of life following spinal decompression surgery among patients with degenerative spine disease. SETTING: Neurosurgical clinic at Saint Michael's Hospital in Toronto, Canada. METHODS: A total of 19 patients with degenerative spine disease who had undergone spinal decompression surgery within the past 14 months filled out social support, life stress, and quality of life questionnaires. Correlational techniques were used to assess the relations among the variables. RESULTS: The correlations between social support scores and health-related and nonhealth-related quality of life scores were r=0.72, P=0.001, and r=0.50, P=0.028, respectively. The correlations between life stress scores and health-related and nonhealth-related quality of life scores were r=-0.83, P<0.001, and r=-0.72, P=0.001, respectively. CONCLUSIONS: Degenerative spine disease patients experiencing more social support and less life stress tend to report greater satisfaction in medical outcome and overall quality of life following spinal decompression surgery than those with less social support and more life stress. Assessing social support and life stress in patients with degenerative spine disease and including a consideration of social support and life stress in the management of patients with degenerative spine disease could help to improve patients' satisfaction with their medical outcome and general quality of life following spinal decompression surgery.

Adult↗
PubMed1993

Quality of life and antihypertensive therapy in men. A comparison of captopril with enalapril. The Quality-of-Life Hypertension Study Group.

BACKGROUND: We conducted a multicenter trial comparing two angiotensin-converting-enzyme inhibitors to determine whether effects on quality of life during antihypertensive therapy are uniform within this pharmacologic class of agents, and to relate the effects of the drugs on quality of life to objective adverse events, such as the loss of a job or the death of a spouse. METHODS: After a four-week washout period when they received placebo, 379 men with mild-to-moderately-severe hypertension were randomly assigned to receive captopril (25 to 50 mg twice daily, with or without hydrochlorothiazide) or enalapril (5 to 20 mg per day, with or without hydrochlorothiazide) for 24 weeks. Blood pressure, quality of life, and life events were monitored. Differences between treatments were evaluated by calibrating measures of quality of life with objective life events. RESULTS: Throughout the treatment period, no differences were found in blood pressure, frequency of withdrawal of patients from the study, or major side effects. Patients treated with captopril had more favorable changes in overall quality of life, general perceived health, vitality, health status, sleep, and emotional control (P < 0.05 for each). The changes varied according to the quality of life at base line (P < 0.001); patients with a low quality of life at base line remained stable or improved with either drug, whereas those with a higher quality of life remained stable with captopril but worsened with enalapril. The quality-of-life scales correlated with life events and symptom distress (P < 0.001), and calibration analysis indicated that differences between treatments were clinically important. CONCLUSIONS: Two angiotensin-converting-enzyme inhibitors, captopril and enalapril, indistinguishable according to clinical assessments of efficacy and safety, had different effects on quality of life. Calibration with life events showed that drug-induced changes are substantial and that the different effects of these two agents on quality of life can be clinically meaningful.

Affective Symptoms↗
PubMed1999

[Physio-social activities and active life expectancy, life expectancy in Japanese elderly].

PURPOSE: Incidence of loss of activity and death in elderly people living at home were investigated to attempt to determine their relationship to physio-social activities in elderly. METHOD: This longitudinal study of life expectancy and active life expectancies is a thirty-six months follow up study. Loss of activities were classified as follows: Long term (over six months) treatment at home, long term (over six months) admission to hospital or intermediate institute for the elderly, admission to nursing home, and death. Subjects were persons living at home in Ogi, Saga prefecture, aged 70 years or older not requiring help in active daily living (ambulating, bathing, dressing, discharging, eating). RESULTS: 6,274 (male = 2,383, female = 3,891) subjects were followed for thirty six months, and 178 people experienced long term treatment at home, 310 people had long term admission to a hospital or intermediate institute for elderly, 28 people were admitted to a nursing home and 449 people experienced death. The main results were as follows: (1) From the Cox proportional hazards model using the likelihood-ratio method of survival and active life loss, significant hazard ratios for reduction active life expectancy for male were found for age, disability score for ADL, speech disorder, inconvenient bathroom design, with attention to health, and daily activity were associated with extension of active life expectancy. Age, disability score for ADL, speech disorder, inconvenient bathroom design were associated with reduced life expecting, while, attention to health, choosing to undergo regular health examinations, and daily were associated with increased activity in life expectancy. (2) Hazard ratios for reduction active life expectancy for females were age, disability score for ADL, defect of memory deficits, inconvenient design for hallway and stairs. Participating in health examinations, Purpose in life were associated with life expectancy increase. For females were age, disability score for ADL, speech disorder, inconvenient design of bathroom were associated with decrease in life expectancy, while having a person in life was associated with increase in life expectancy. DISCUSSION: Relationship between physio-social activities in elderly is a significant factor in many studies on elderly health. This study suggests that age, disability score for ADL, inconvenient for housing design, active health behavior, daily activities, and Losing a sense of worth in living, affect active life expectancy and life expectancy.

Activities of Daily Living↗
PubMed1994

Failure of infinite life span human cells from different immortality complementation groups to yield finite life span hybrids.

The observation that fusion of infinite life span cells with finite life span cells produces hybrid cells with finite life spans led to the conclusion that an infinite life span in culture is a recessive trait resulting from loss of the function of a gene or genes that contribute to an active program for cellular senescence. Furthermore, finding that certain pairs of infinite life span cells, when fused to one another, can complement each other to yield finite life span hybrids allowed 30 infinite life span cell lines to be assigned to four immortality complementation groups (Pereira-Smith and Smith, 1988, Proc. Natl. Acad. Sci. U.S.A., 85:6042). In the present study, we fused a chromosomally stable, near diploid, morphologically normal, infinite life span cell strain, designated MSU-1.1, with its normal, finite life span, precursor cell strain and obtained finite life span hybrids, as expected if infinite life span in culture is a recessive trait. However, 14 of the 14 hybrids from our fusions of MSU-1.1 cells with representative cell lines from each of the four immortality complementation groups, and 38 of the 39 hybrids from our fusions of infinite life span cells that have been reported to complement each other, failed to exhibit finite life spans. This result suggests that infinite life span cells cannot complement each other to yield finite life span hybrids. In examining this unexpected result, we obtained evidence that long-term dual drug selection can be deleterious to hybrid cells even though they carry resistance markers for both drugs, indicating that the cell death of such hybrids observed in other studies may have resulted from the cytotoxic effect of long-term drug selection, rather than from senescence.

Cell Death↗
PubMed1995

The quality of life of patients with life-threatening arrhythmias.

BACKGROUND: The treatment of life-threatening arrhythmias with amiodarone or an implantable cardioverter/defibrillator prolongs patient survival but with significant comorbidity. Previous studies have shown diminished health status and increased psychologic distress and inferred a diminished quality of life; however, a multidimensional analysis of quality of life, including patient perception, has not been performed. METHODS: One hundred four consecutive patients were surveyed regarding patient demographics, health status, psychologic distress, and patient-perceived quality of life. The patients were treated with amiodarone (n = 30) with an implantable cardioverter/defibrillator (n = 45) and the remainder were reference patients (n = 29). RESULTS: This study confirms that patients who survive life-threatening arrhythmias have diminished health status and increased psychologic distress; however, patient-perceived quality of life is preserved. These patients report a better perceived quality of life (as measured by the Quality of Life Index) than the reference group (22.3 +/- 4.0 vs 20.5 +/- 4.4, P < .05) and their scores are similar to those of normal healthy volunteers (mean score, 21.9). The improved quality of life scores were not dependent on treatment modality (22.1 +/- 4.0 vs 22.4 +/- 4.1 for medical vs surgical groups, respectively). CONCLUSIONS: Patient-perceived quality of life is maintained in patients who survive life-threatening arrhythmias despite their diminished health status and increased psychologic distress. Measured quality of life is independent of treatment modality. Thus, caution must be exercised in assuming a diminished quality of life in patients who have survived a life-threatening cardiac event.

Aged↗
PubMed2006

Quality of life and events in the first year of life. Results from the prospective Copenhagen Birth Cohort 1959-61.

The objective of this paper was to explore the association between diverse factors occurring during the first year of a child's life and the quality of life later as an adult. The design was a prospective cohort study based on material from the Copenhagen Birth Cohort 1959-61 with 7,222 participants and two sets of questionnaires used: one by a physician during the child's first year and one by the "adult child" 31-33 years later. The results showed that a mother's attitude towards her pregnancy, unsuccessful abortions, and/or institutionalization left a permanent trace on the child, since these children, as adults, have a quality of life 3% below the average. Meningitis during the first year of life resulted in a quality of life 11.7% below the average, while other illnesses or accidents did not have an effect. The largest associations were found with psychomotor development, where "walking with support" showed a difference of 14.2% in overall quality of life between the fastest and slowest group. Generally, diet is not correlated with quality of life, however, we find a small, but essential, correlation between the quality of life of the adult and the early cessation of suckling (4%). Full-time institutionalization during the first year of life showed a connection with the quality of life of the adult (7.1%). It is concluded that our quality of life, health and ability as adults are primarily determined by what we ourselves choose to do with our lives as young people and as adults--and only to a marginal degree determined by factors related to our background. This suggests that we as adults have a great freedom to achieve a good life despite our experiences in the beginning of life.

Adult↗
PubMed2000

Lord, now you are letting your servant depart in peace: a theoretical model, combining quality of life and years of life, which offers clues for the proper time to die with dignity.

"Lord, now you are letting your servant depart in peace according to your word" said Saint Symeon (New Testament, Luke 2, 29). But, which is this day? How can we know it? In this article we re-examine theoretically, using a "thought experiment", the ancient dilemma of "when is the proper time to die". It is a contribution to the international debate on quality of life, quality of death, and dying with dignity. Quality is defined as a variable, which incorporates every other dimension of life except time (except years of life). It is accepted that a heuristic definition of life is the product of duration and quality, and, since quality can be negative, we accept the idea that life can be negative as well. Given that, the proper time to die in dignity is when life, from being positive becomes negative. After that we examine the individual as a member and part of the society in which he belongs and we conclude that negative life can be prolonged only be consuming positive life of other members of the society; this means that negative life in a hypothetical one-member society cannot exist; a critical population size is necessary. Finally, rising to the society level, and having defined society's life as the sum of every person's life, we discovered that preserving the negative life of some people can only be possible by consuming the positive life of other members of this society or/and other society (ies) or/and of the whole biosphere. Now the question is raised whether this is ethical or not, whether it is a human right and, if so, whose?

Ethics, Medical↗
PubMed2001

Whose life task is it anyway? Social appraisal and life task pursuit.

The study uses a social contextual framework to examine how others are represented in individuals' life task appraisals and how such appraisals are related to strategies to pursue those life tasks. The extent to which life tasks nominated by 81 college students (45 females) were appraised as shared with others and pursued collaboratively was examined through a questionnaire. Participants listed five life tasks, indicated if each life task was theirs alone, indirectly shared (others were impacted by their life task pursuit), or directly shared (another person might also nominate the life task as theirs) with others in their lives, described three activities used to pursue their life tasks, and coded how others were involved inthese activities. Results indicated that the majority of college students' life tasks were appraised as involving others, that directly shared appraisals were found more frequently in the relationship domain, and that directly shared appraisals were associated with collaborative life task pursuit strategies. In addition, appraising life tasks as directly shared did not appear to reflect aspects of anxiety or compensation. A content analysis of the strategies coded as involving other individuals revealed diverse ways in which others are involved in life task pursuit ranging from active engagement of others to cognitive strategies where others are implied. The findings have implications for research on life tasks and other goal structures in that the structures may involve the social context in adaptive ways.

Adolescent↗